Analysis of Viral Load Response in Children Living with HIV Aged 5- 19 Years on Antiretroviral Treatment at 9 Bulawayo City Clinics, Zimbabwe, 2021- 2023

Abstract

Zimbabwe is one of the countries in sub-Saharan Africa disproportionately affected by the human immunodeficiency virus. The country has made great strides in scaling up ART using the “treat all” strategy. Regular viral load monitoring is essential for managing HIV effectively, particularly in children. However, the viral load suppression remains below the target of 95% that the country aims to achieve. A retrospective cohort study using secondary data analysis was done to analyse viral load response in CLHIV aged 5-19 years initiated on ART at nine BCC-supported clinics from January 2021 -June 2023. The viral response was measured using documented viral load results for VL samples done 6-9 months post ART initiation. A total of 199 study participants were included in the study. Convenience sampling was used to select the nine facilities and study participants were selected through random stratified sampling. The results show that 86.5% of participants underwent viral load testing at six to nine months post ART initiation to measure viral load response. 74.4% were virally suppressed,12.1% were unsuppressed and 13.6% had unknown viral load response due to missed opportunities even though they were active on treatment. There was a statistical significance between adherence and viral load response (p= 0.000), age group and gender (p = 0.001), orphan status and adherence (p=0.035). There was a strong association between adherence level and viral load (Cramer’s V=0.497). In addition, there was a moderate association between age group and adherence (Cramer’s V=0.262) and orphan status and adherence (Cramer’s V=0.209). Viral load suppression was highest for the age group 5-9 years at 94.1%, followed by the 10-14 age group with the least performance by the 15-19 years age group at 70.2%. Notably, the 15-19 years age group accounted for 91.7% of the total participants with unsuppressed viral load. However, statistically, findings show no significance (p=0.155). Conclusion: At six months of ART, viral suppression was low and significant missed opportunities for viral load monitoring in the cascade There is an urgent need to scale up the implementation fidelity of routine viral load monitoring to mitigate missed opportunities. In addition, to improve treatment literacy.